Down and Out: The story of one mother’s journey -- Part 6
The Paxil Problem and Other Therapy Solutions
“I’m taking all my pediatric patients off Paxil,” Dr. Thornton phoned to tell me on an otherwise sunny day in April. “I just read a British study that said children should not take Paxil because of a possible increase suicidal risk. The study showed that this risk occurred early in the treatment. That suggests to me that there were suicidal tendencies before the Paxil. The FDA plans to conduct their own study, but I don’t want to wait for their research which may take years.”
While the study did not take years, only months, its findings were the same:
“The Food and Drug Administration issued a warning in October 2004 that antidepressant medications, including SSRIs, may increase suicidal ideation and suicidal behaviors in a small number of children and adolescents. Analyses of the studies showed that the average risk of suicidal ideation and suicidal behaviors occurred in 4% of patients treated with an antidepressant, compared to 2% of patients who were treated with a placebo (sugar pill). No suicides occurred in any of the studies,” wrote the National Institute of Mental Health.
Paxil, while never the perfect pill, kept a lid on Nicholas’ anxieties and depression. Off the Paxil, he faced increased tics and more bouts with depression that left him unable to face the day. He constantly rubbed his month, leaving sores, cracked and bleeding. The dark circles under his eyes gave him an almost ghoulish appearance. Back on the Remeron he went, and Dr. Thornton introduced a new medication: Lexapro.
We’ll try it. We’ll try anything. I desperately wanted my son’s dark moods to go away. I didn’t want Nicholas to question why he was alive. Not at this age, not at any age. At nine years old, Nicholas held the weight of the world on his shoulders. Television news became an obsession unless we hid the television. The sight of a passing ambulance, its lights flashing, would raise disturbing questions. Trips to Seattle meant handing out dollar bills to every street person along our route…and more unsettling questions. A bad day at the office meant we too were not far from the streets.
Few people understood our situation. Few people saw what we saw, a troubled young boy, his tortured mind revealed only in school photos or in the safety of his own home.
Perhaps it was the new medication or maybe it was a new level of maturity, but whatever the root, Nicholas seemed open to trying a new therapist. He still had little to say but was willing to sit in yet another office. “I’m sad Mom, but I don’t know why,” he whispered as we drove to his first session with Ben Silverman.
When I interviewed Ben for the roll of therapist in my son’s life, he explained the term Cognitive-Behavioral Therapy. “Cognitive-behavioral therapy is based on the scientific fact that our thoughts cause our feelings and behaviors, not other people, situations, or events.”
He must have seen me flinch because he went on to say, “Nicholas does also have a chemical imbalance that you’ve addressed through medication. But you don’t want him to be on medication his whole life do you? What kind of message are you sending him if the only relief he feels is when he pops a pill?”
“Okay, you have my attention.”
“Look, Nicholas is a very bright boy. Too bright which is probably a major part of his problem. He thinks too much. Unfortunately he thinks about the wrong things. That’s why we need to help him shift his thinking.”
I looked Ben in the eye, “That’s what other therapists said but he never established a relationship with any of them and there was never a sense of trust.”
“With cognitive therapy it’s not about the relationship between the therapist and the client. That’s important of course. But the focus of this type of therapy is teaching self-counseling skills. I’m not going to tell him how he should feel. Yes, he’s an otherwise healthy young boy, and you and I both think he should feel happy and carefree, but the reality is that he doesn’t feel that way. Now you’ve added guilt to his list of feelings because he KNOWS you want him to feel happy and he just doesn’t feel that way.”
And so we scheduled weekly sessions. “What happened before your started feeling bad?|” Ben asked Nicholas after several “getting to know you” meetings. When he didn’t answer, Ben went on “What does sad feel like to you?”
This time Nicholas responded, not immediately, only after several minutes of thinking, but finally he replied, “I feel stuck.”
“Do you want to feel this way?”
Nicholas shook his head, “No.”
“Can you think of something that will make you feel better?”
Again Nicholas shook his head.
“May I give you a project for the next time we meet?”
“Okay,” Nicholas said reluctantly.
“This isn’t a big school assignment or even an assignment that you HAVE to do. Your mom can help you. At the end of each day, would you write down how you felt that day? Write down what you did – went to school, played soccer, whatever it was. Then write down how you felt afterwards. You know, happy, sad, upset, silly. That’s all there is to it.”
As we left the office, Ben patted me on the back. “You’re doing all the right things for your son. He’ll do well because of you.”
Because of me or in spite of me?
Part Seven: Who’s Taking Care of Mom?
Read the beginning of the series:Read Part One, Part Two, Part Three, Part Four, Part Five.
